<%-- 
    Document   : jspPerfil
    Created on : 20/09/2011, 12:18:28 AM
    Author     : yohanna
--%>

<%@page contentType="text/html" pageEncoding="UTF-8"%>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   "http://www.w3.org/TR/html4/loose.dtd">

<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title>JSP Page</title>
    </head>
    <body>
        <form class="jotform-form" action="http://submit.jotform.com/submit.php" method="post" name="form_12611133268" id="12611133268" accept-charset="utf-8">
  <input type="hidden" name="formID" value="12611133268">
  <div class="form-all">
    <h2 id="header_1" class="style2">Mis acciones
          </h2>
	<h2 class="style3">Mi perfil
          </h2>
    <ul class="form-section">
      <li class="form-line" id="id_4">
        <label class="form-label-left" id="label_4" for="input_4">
		Identificación: </label>
          <input type="text" class="form-textbox" id="input_4" name="q4_identificacion" size="20"><div id="cid_4" class="form-input">
          &nbsp;</div>
      </li>
      <li class="form-line" id="id_5">
        <label class="form-label-left" id="label_5" for="input_5"> Nombre y Apellido del usuario </label>
        <div id="cid_5" class="form-input"><span class="form-sub-label-container">
			<input class="form-textbox" type="text" size="10" name="q5_nombreY[first]" id="first_5" style="width: 178px">
            <label class="form-sub-label" for="first_5" id="sublabel_first"> Nombre </label></span><span class="form-sub-label-container">
			<input class="form-textbox" type="text" size="15" name="q5_nombreY[last]" id="last_5" style="width: 199px">
            <label class="form-sub-label" for="last_5" id="sublabel_last"> Apellido
			<br />
			</label></span>
        </div>
      </li>
      <li class="form-line" id="id_6">
        <label class="form-label-left" id="label_6" for="input_6"> Datos del usuario: </label>
        <div id="cid_6" class="form-input">
          <textarea id="input_6" class="form-textarea" name="q6_datosDel" cols="40" rows="6"></textarea>
        	<br />
			<h2 id="header_8" class="style4">Cambiar contraseña
          </h2>
        </div>
      </li>
      <li class="form-line" id="id_9">
        <label class="form-label-left" id="label_9" for="input_9"> Contraseña:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </label>
          <input type="password" class="form-textbox" id="input_9" name="q9_contrasena" size="20"><div id="cid_9" class="form-input">
          &nbsp;</div>
      </li>
      <li class="form-line" id="id_10">
        <label class="form-label-left" id="label_10" for="input_10"> Repite la contraseña: </label>
          <input type="password" class="form-textbox" id="input_10" name="q10_repiteLa" size="20"><div id="cid_10" class="form-input">
          &nbsp;</div>
      </li>
      <li class="form-line" id="id_11">
        <label class="form-label-left" id="label_11" for="input_11">
          Introduzca el mensaje que aparece<span class="form-required">*</span>
        </label>
        <div id="cid_11" class="form-input">
          <div class="form-captcha">
            <label for="input_11">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <img alt="Captcha - Reload if it&#39;s not displayed" id="input_11_captcha" class="form-captcha-image" style="background:url(http://www.jotform.com/images/loader-big.gif) no-repeat center;" src="./Mis acciones_files/server.php" width="150" height="41"> </label>
            <div style="white-space:nowrap;">
              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
              <input type="text" id="input_11" name="captcha" style="width:130px;" placeholder="Escriba el texto anterior">
              <img src="./Mis acciones_files/reload.png" alt="Reload" align="absmiddle" style="cursor:pointer" onclick="JotForm.reloadCaptcha(&#39;input_11&#39;);"/>
              <input type="hidden" name="captcha_id" id="input_11_captcha_id" value="da117742e49c436d5551fcd581a063ce">
            	<br />
            </div>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_2">
        <div id="cid_2" class="form-input-wide">
          <div style="margin-left:156px" class="form-buttons-wrapper">
            <button id="input_2" type="submit" class="form-submit-button">
              Cambiar
            </button>
          </div>
        </div>
      </li>
      <li style="display:none">
        Should be Empty:
        <input type="text" name="website" value="">
      </li>
    </ul>
  </div>
  <input type="hidden" id="simple_spc" name="simple_spc" value="12611133268-12611133268">
  <script type="text/javascript">
  document.getElementById("si" + "mple" + "_spc").value = "12611133268-12611133268";
  </script>
</form>
        <h1>Hello World!</h1>
    </body>
</html>
